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features
design
support

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Description

ClaimScore stands out as the sole independent software solution focused on tackling the growing issue of claim fraud within class action settlements. Each claim is meticulously assessed on an individual basis through our unique AI, ML, and Cloud Architecture in real-time, with results displayed instantly on an interactive dashboard. Initially, every claim starts with a ClaimScore of 1,000, which diminishes whenever it does not meet a specific criterion. These criteria are assigned either fixed or variable weights based on their relationship to fraudulent and legitimate claims. To enhance transparency, every claim is accompanied by deduction codes that correspond to the failed criteria, ensuring that all involved parties, including the administrator and the court, are fully informed of the precise reasons behind any claim rejection. This meticulous approach not only fosters trust among stakeholders but also reinforces the integrity of the claims process.

Description

Instilling Quality is a distinctive quality assurance tool designed to objectively evaluate and score the accuracy and comprehensiveness of follow-up actions on accounts, tailored by user. This tool is part of the Resolution Queue™, a proprietary and customizable workflow software from PwC for managing healthcare accounts receivable (A/R), but it is also available for separate licensing and can function independently based on user requirements. The Instilling Quality software randomly assesses the work done by collection specialists and assigns a numerical score reflecting the thoroughness and completeness of each account. Users can specify the exact criteria necessary for scoring accounts accurately. The quality review process is informed by a user score's rolling average over 90 days. As a result, team members with higher scores face a reduced number of accounts for review, whereas those with lower scores will have more accounts queued to ensure continuous improvement in the review process. This approach not only incentivizes quality work but also systematically enhances the overall efficacy of account management.

API Access

Has API

API Access

Has API

Screenshots View All

Screenshots View All

Integrations

No details available.

Integrations

No details available.

Pricing Details

No price information available.
Free Trial
Free Version

Pricing Details

No price information available.
Free Trial
Free Version

Deployment

Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook

Deployment

Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook

Customer Support

Business Hours
Live Rep (24/7)
Online Support

Customer Support

Business Hours
Live Rep (24/7)
Online Support

Types of Training

Training Docs
Webinars
Live Training (Online)
In Person

Types of Training

Training Docs
Webinars
Live Training (Online)
In Person

Vendor Details

Company Name

ClaimScore

Founded

2022

Country

United States

Website

www.claimscore.ai

Vendor Details

Company Name

PwC

Founded

1998

Country

United Kingdom

Website

www.pwc.com/us/en/products/instilling-quality.html

Product Features

Insurance Claims Management

CRM
Claims tracking
Customer portal
Document management
EDI data exchange integrations
Electronic claims
Fraud management
Reporting

Product Features

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